Rheumatoid Arthritis Drugs

Background

Rheumatoid arthritis, which afflicts more than 1.3 million adults in the United States, can leave you with swollen, stiff, and painful joints and can lead to irreversible joint damage if left untreated. Injectable drugs referred to as biologic DMARDs (Disease-Modifying Antirheumatic Drugs)—or simply, biologics—can help relieve these symptoms and may help prevent further joint damage. But they can cause serious side effects, so they should not be used until after you have tried other therapies.

To help you and your doctor choose the right biologic if you need one, Consumer Reports Best Buy Drugs has evaluated the drugs in this category based on their effectiveness, safety, and cost. This brief is a summary of a longer report you can access on the Internet at CRBestBuyDrugs.org. You can also learn about other drugs we’ve analyzed on this free Web site.

Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need a Rheumatoid Arthritis Drug?

The biologics can cause serious side effects and should not be used until after you have tried other therapies. In some cases, a biologic may not be appropriate. If you have been newly diagnosed with rheumatoid arthritis, studies show that other less costly and safer medications work just as well as biologics, so you should try these first. These include ibuprofen (Advil, Motrin, and generics), naproxen (Aleve, Naprosyn, and generics), corticosteroids such as prednisone, and nonbiologic DMARDs, including hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), minocycline (Dynacin, Minocin), and methotrexate (Rheumatrex). You should also follow an exercise program because studies show such programs improve function in people with rheumatoid arthritis.

If those therapies fail to provide you with enough symptom relief, then it may be time to try a biologic. Between 40 to 70 percent of people who have not benefitted from other rheumatoid arthritis medications experience some measure of relief from biologics.

Prescribing Biologics

Your doctor should not prescribe a biologic if:

Your doctor may decide not to prescribe a biologic if:

■ Your rheumatoid arthritis is not active (i.e., your arthritis is in remission)

■ You have not tried a conventional DMARD first

■ You have an infection

■ You have previously had severe reactions to biologics

■ You are pregnant or breastfeeding

■ You have had tuberculosis in the past

■ You have had other repeated infections

■ You have had cancer

■ You have or had a serious heart condition

■ You have lung fibrosis

Effectiveness and Tolerability of Biologics

Generic Name

Brand Name

Response to Treatment1

Discontinuation Because of Side Effects2

Comments/Special Notes

Abatacept

Orencia

26%-40%

3%-7%

Low rate of infusion reactions

Adalimumab

Humira

24%-97%

5%-9%

None

Anakinra

Kineret

19%-50%

Not reported

Highest rate of injection site reactions

Certolizumab

Cimzia

24%-41%

1%-7%

Highest rate of serious infections

Etanercept

Enbrel

47%-100%

3%-57%

None

Golimumab

Simponi

16%-40%

2%-6%

None

Infliximab

Remicade

27%-75%

2%-20%

Higher rate of infections than Orencia and Enbrel

Rituximab

Rituxan

18%-49%

1%-6%

Highest rate of infusion reactions3

Tocilizumab

Actemra

29%-54%

4%-12%

None

1. Response is defined as an at-least 50 percent improvement of rheumatoid arthritis symptoms. Based on multiple studies and combined analysis of studies, or from the drug’s product label information. Figures are not meant to imply that drugs were necessarily compared to each other in a study with consistent design.

2. Average discontinuation rates due to adverse events seen in studies. Based on multiple studies and combined analysis of studies, or from the drug’s product label information. Figures are not meant to imply that drugs were necessarily compared to each other in a study with consistent design.

3. 77 percent of people treated with rituximab had a reaction after the first infusion.

Our Recommendations

Nine different biologics are available to treat the symptoms of rheumatoid arthritis, but they are not a cure. They are all very expensive, with some costing more than $5,000 per week. Taking into account the evidence for effectiveness and safety, if you need a biologic drug to treat your rheumatoid arthritis, we have chosen the following as Consumer Reports Best Buy Drugs:


■ Abatacept (Orencia)

■ Adalimumab (Humira)

■ Etanercept (Enbrel)


Studies show that these three medications are as effective as the other biologics for relieving rheumatoid arthritis symptoms, and they also may have lower rates of withdrawal due to adverse effects than some other biologics.

All of the biologics can cause side effects. In studies, people who took a biologic had a higher risk—13% versus 12%—of experiencing a serious life-threatening allergic reaction, infection, lymphoma, or other serious side effect than those who took a placebo. The serious or potentially life-threatening infections include bacterial infections, such as tuberculosis, pneumonia, or staph, and serious fungal infections. Minor side effects, such as abdominal pain, nausea, and injection site reactions, can also occur, but usually do not require stopping or changing drugs.


This report was published in March 2013.

Cost Comparison

Generic Name and Dose

Brand Name

Frequency of Use

Average Monthly Cost1

Abatacept 125 mg/mL2

Orencia

Every 4 weeks for intravenous injection.

Once a week for subcutaneous injection.

Given every 4 weeks: $2,215

Given every week: $2,737

Adalimumab 40 mg, injectable kit

Humira

Every week or every other week

Given every other week: $2,632

Given every week: $5,264

Adalimumab 40 mg, pen injector

Humira

Every week or every other week

Given every other week: $2,654

Given every week: $5,308

Anakinra 100 mg, disposable syringes

Kineret

Daily

$1,796

Certolizumab 400 mg, injectable kit

Cimzia

Every other week

$2,739

Etanercept 25 mg, prefilled syringe

Enbrel

Once a week

$1,197

Etanercept 50 mg, prefilled syringe

Enbrel

Once a week

$2,444

Etanercept 50 mg, pen injector

Enbrel

Once a week

$2,690

Golimumab 50 mg, prefilled syringe

Simponi

Every 4 weeks

$2,880

Golimumab 50 mg, pen injector

Simponi

Every 4 weeks

$2,864

Infliximab 100 mg2

Remicade

Every 4-8 weeks3

Given every 8 weeks: $2,2964

Given every 4 weeks: $4,5924

Rituximab 10 mg/mL

Rituxan

Every 24 weeks3

$1,3244

Tocilizumab 200 mg/10 mL

Actemra

Every 4 weeks

$1,7975

Tocilizumab 400 mg/20 mL

Actemra

Every 4 weeks

$1,8255

1. Prices are derived from national average retail costs for December 2012, rounded to the nearest dollar. Information is derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

2. Calculated price is based on an assumed body weight of 75 kg (165 pounds).

3. Refers to an average interval; number of infusions required varies among people.

4. A typical course requires closer intervals in the beginning. Average costs during the first year of treatment, therefore, may be substantially higher.

5. Price might be unreliable because it is based on less than 20 prescriptions.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, non-commercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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